Audiology Infection Control Practices

1. AudiologyInfection Control Practices Bruce Gamage, BSN CIC Infection Control Consultant BCCDC

2. Outline • Basic risk factors in patients • Risk of cross-contamination • Chain of Infection • Spaulding classifications • Scope of practice • Routine • High risk procedures • Routine Practices • Employee Health • BBF exposure

3. Patient Risk Factors • All treatment offered should minimize potential disease transmission • Patients may have underlying disease • May be immunosuppressed • Drug related • Leads to increase risk of infection from opportunistic organisms

4. Chain of infection Agent Environment Transmission Host

5. Agent • Infectiousness • Pathogenicity • Source • Period of infectivity • Portal of exit

6. Transmission • Contact spread • Common vehicle spread • Airborne spread • Vectorborne spread

7. Host • Portal of entry • Non specific defense mechanisms • Skin, tears, mucous membranes, stomach acid, inflammatory response • Specific Immunity • Natural immunity, vaccinations • Host response

8. Environment • Don’t over emphasize! • Temperature • Humidity • Cleanliness

9. Risk of cross-contamination • Patients and technicians • Variety of contacts with environment and objects • Direct or indirect contact with multiple patients

10. Spaulding’s Classifications • Critical items • Penetrate the skin, contact blood, unintact mucous membranes require sterilization • E.g. curettes, wax loops, imittance and autoacoustic emissions probe tips, ear impression syringes and otoscopic specula • Many of these items are available as disposables

11. Spaulding's Classifications • Semi-critical • Contact intact mucous membranes - require high-level disinfection • Non-critical • Contact intact skin only - sterilization not required • Require cleaning and disinfection

12. Cleaning • Remove gross contamination • Most important step to disinfection or sterilization as soil will inhibit the process • Accomplished with brush, wipe or ultrasonic machine

13. Disinfection • Kills specific organisms depending on chemical used • QAC, Phenolic will kill vegetative bacteria, enveloped viruses (e.g. Hep B, C, HIV) • Aldehydes, Concentrated Hydrogen peroxide, chlorine (bleach) will kill fungus, and enveloped viruses dependent on contact time. Not bacterial spores • Prolonged contact time can provide sterilization. (must follow manufacturer’s recommendations for concentration and contact time)

14. Disinfection • Disinfection is acceptable for non-critical items – items that do not penetrate the skin, touch mucous membranes • Noncritical items: • Earmolds, • “in the ear” hearing aids • Supra-aural headphones • Otoscope specula • Probe tips • Electrodes • All items should be cleaned and disinfected between patients

15. Disinfecting the Environment • Surfaces in work areas should be disinfected regularly • Disinfectant wipes/squirt bottle • Waiting room toys • “Your saliva is my saliva”

16. Sterilization • Kills all microbes, including spores • Autoclaves • Uses moist heat • Must be used correctly • Must be monitored • Cold Sterilization • Usually accomplished soaking in a chemical sterilant (e.g. 2% gluteraldehyde, 7.5% hydrogen peroxide) • Requires correct contact time and concentration • Solutions should be monitored

17. Disposables • Many items involved in cross-contamination are available as disposables • Otoscope specula, probe tips, earmold impression syringe tips, insert receivers, probe microphone tubes. • May be cleaned and reused on same patient • Re-use of disposables between patients • Don’t go there!

18. Scope of Practice • Routine procedures • More invasive procedures • Exposure to body fluids • Interoperative monitoring of cranial nerves • Sensory evoked potentials • Insertion needle electrodes • Vestibular procedures (vomiting) • Cerumen

19. Routine Practices • Aimed at controlling exposure between people and the environment/objects • Varies with the nature of the contact from simple cleaning sterilization • Responsibility of Clinician to provide a safe work environment for themselves, their colleagues and their patients • Assume that every patient is potentially infectious

20. Routine Practices • Handwashing • Soap • Antibacterial soap • Alcohol based hand rubs • Equivalent to a handwash as long as hands are not visibly soiled

21. Routine Practices • Gloves • Should be worn for all procedures where risk of exposure to body fluids ( e.g. cerumen management, draining ear, lesions present, cleaning spills and disinfecting) • Single use • Task specific • Vinyl vs. Latex • Utility Gloves for handling chemicals

22. Routine Practices • Protective apparel • Safety glasses and masks should be worn is risk of splash or spatter of body fluids • Cerumen removal • Working with grinding or buffing wheel • Masks for potential TB patients • Disposable headphone covers for mass screenings

23. Waste Disposal • Waste that is contaminated with blood , body fluids (ear drainage, cerumen) can go in regular garbage unless “dripping” • Saturated materials, tissue, etc. must be placed in biohazardous waste bags • Proper sharps disposal • GVRD regulations require that biohazardous waste/sharps must be picked up and processed (either sterilization or incineration)

24. Employee Health • Vaccinations: • Hepatitis B Vaccine • MMR • Diphtheria/tetanus (every 10 years) • Influenza • Varicella • Hepatitis A? If working with high-risk population

25. BBF exposure • Blood or other potentially infectious body fluids • Intact skin • No risk – wash with warm soapy water • Splash to mucous membrane or sharps injury • High risk – flush with NS, water • Don’t squeeze or soak in bleach • Report to nearest emergency department for: • Assessment – type of exposure/status of source • Baseline blood work • Possible ART

26. Summary • Cross-contamination • Cleaning, disinfection and sterilization • Routine practices Wash Your Hands